Motor Dysfunction In Children Research Articles

Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy

BackgroundCerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP.MethodsThe current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution.ResultsThere was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels.ConclusionsSDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.

Feasibility of wearable technology for 'real-world' gait analysis in children with Prader-Willi and Angelman syndromes.

Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are neurodevelopmental disorders in need of innovative 'real-world' outcome measures to evaluate treatment effects. Instrumented gait analysis (IGA) using wearable technology offers a potentially feasible solution to measure "real-world' neurological and motor dysfunction in these groups. Children (50% female; 6-16years) diagnosed with PWS (n=9) and AS (n=5) completed 'real-world' IGA assessments using the Physilog®5 wearable. PWS participants completed a laboratory assessment and a 'real-world' long walk. The AS group completed 'real-world' caregiver-assisted assessments. Mean and variability results for stride time, cadence, stance percentage (%) and stride length were extracted and compared across three different data reduction protocols. The wearables approach was found to be feasible, with all participants able to complete at least one assessment. This study also demonstrated significant agreement, using Lin's concordance correlation coefficient (CCC), between laboratory and 'real-world' assessments in the PWS group for mean stride length, mean stance % and stance % CV (n=7, CCC: 0.782-0.847, P=0.011-0.009). 'Real-world' gait analysis using the Physilog®5 wearable was feasible to efficiently assess neurological and motor dysfunction in children affected with PWS and AS.

Effect of Acupuncture Combined with Rehabilitation on Motor Dysfunction in Children with Cerebral Palsy and Its Effect on Motor Function

Effect of Acupuncture Combined with Rehabilitation on Motor Dysfunction in Children with Cerebral Palsy and Its Effect on Motor Function

Двигательные дисфункции толстой кишки у детей с хроническим запором: электрофизиологические аспекты

Цель — изучение электрической активности толстой кишки у детей с хроническим запором. Пациенты и методы. Под наблюдением находилось 63 ребенка с хроническим запором (основная группа) и 30 практически здоровых детей (контрольная группа). У всех пациентов проводилось изучение электрической активности толстой кишки методом электроэнтерографии. Состояние слизистой оболочки пищеварительного тракта изучалось с помощью эндоскопического исследования.Результаты. Были выявлены 4 типа нарушения электрической активности толстой кишки у детей при хроническом запоре. Преобладающим нарушением электрической активности толстой кишки является повышение суммарного препрандиального и снижение постпрандиального электрического потенциала. Выявлено, что у детей с наличием воспалительного процесса в слизистой толстой кишки препрандиальная электрическая активность выше по сравнению с группой детей, у которых отсутствовал проктосигмоидит, что приводит к снижению пропульсивной активности толстой кишки после пищевой стимуляции.Выводы. Различные типы нарушения электрической активности толстой кишки требуют дифференцированного подхода к коррекции ее моторной функции. Предложены принципы терапии хронического запора у детей при каждом типе нарушения электрической активности толстой кишки.

"Research Progress on Intervention of Motor Dysfunction in Children with Autism Spectrum Disorder"

"Research Progress on Intervention of Motor Dysfunction in Children with Autism Spectrum Disorder"

The evolution of cerebral palsy publications and global productivity: a bibliometric analysis between 1980 and 2019.

Although cerebral palsy (CP), which affects the quality of life of many children and their families, is the most common cause of motor dysfunction in children, no comprehensive bibliometric study has holistically evaluated the publications on CP. This study aimed to analyze the scientific outputs published on CP in pediatrics research between 1980 and 2019 using bibliometric and statistical methods, and reveal new study trends in this field. The literature search was performed in the Web of Science database using the keyword cerebral palsy in the title section of the articles published only in the pediatrics research field. Four-thousand seventy-five publications were obtained in the field of pediatrics research on CP, 3027 of which were articles. We shared abstract information of 3027 articles published between 1980 and 2019 with this comprehensive bibliometric study, which will be a useful guide for physicians and scientists on the global outcomes of CP, and we discussed new trends in this topic. We think that comprehensive bibliometric analyzes on subjects that we frequently encounter in clinics and which are widely researched will contribute to the field.

Rehabilitation strategy and recommendation for motor dysfunction in children with cerebral palsy

脑性瘫痪（脑瘫）是终生性疾患，主要问题为运动障碍和姿势异常，其严重程度存在明显个体差异（从可独走到不能抬头），给家庭和社会带来沉重负担。脑瘫尚无法治愈，也没有明确的策略预防，对症康复是改善脑瘫运动障碍的关键，但尚无一致性的可操作的治疗推荐意见。中华医学会儿科学分会康复学组讨论并提出儿童脑瘫运动障碍的康复建议，以期规范和指导儿童脑瘫的康复治疗与管理。.

Acupuncture treatment on the motor area of the scalp for motor dysfunction in children with cerebral palsy: study protocol for a multicenter randomized controlled trial

BackgroundScalp acupuncture has been widely used as treatment for motor dysfunction in children with cerebral palsy in China. Previous studies have failed to provide high-quality evidence to demonstrate the effectiveness of this treatment in children with cerebral palsy. No high-quality randomized controlled trials on scalp acupuncture have been published. The aim of this study is to evaluate the effectiveness of Jiao’s scalp acupuncture when combined with routine rehabilitation treatment versus routine rehabilitation treatment alone for motor dysfunction in children with cerebral palsy.Methods/DesignThis is a four-centre randomized controlled trial. One hundred cerebral palsy patients with motor dysfunction were enrolled. Patients will be allocated in a 1:1 ratio into either an acupuncture treatment group or a control group. Cerebral palsy patients in the control group will receive conventional rehabilitation treatment, whereas patients in the acupuncture group will receive a combination of scalp acupuncture and conventional rehabilitation treatment. Thirty-six treatment sessions will be performed over a 12-week period. The Gross Motor Function Measure and the Fine Motor Function Measure Scale will be assessed as the primary outcome measures. The Paediatric Evaluation of Disability Inventory and the Cerebral Palsy Quality of Life Questionnaire for Children will be selected as secondary outcome measures. All assessments will be conducted at baseline, week 4 (treatment 12), week 8 (treatment 24), week 12 (treatment 36) and week 24 (follow-up).DiscussionThis is the first trial evaluating the efficacy and safety of scalp acupuncture as a treatment for motor dysfunction in children with cerebral palsy. The results of this trial are expected to provide relevant evidence demonstrating that scalp acupuncture can be used as an effective rehabilitation treatment method for improving motor dysfunction in children with cerebral palsy.Trial registrationClinicalTrials.gov, NCT03921281. Registered on 19 April 2019.

Quantitative gait assessment in children with 16p11.2 syndrome

BackgroundNeurodevelopmental disorders such as 16p11.2 syndrome are frequently associated with motor impairments including locomotion. The lack of precise measures of gait, combined with the challenges inherent in studying children with neurodevelopmental disorders, hinders quantitative motor assessments. Gait and balance are quantifiable measures that may help to refine the motor phenotype in 16p11.2. The characterization of motor profile is useful to study the trajectories of locomotion performance of children with genetic variants and may provide insights into neural pathway dysfunction based on genotype/phenotype model.MethodsThirty-six children (21 probands with 16p11.2 deletion and duplication mutation and 15 unaffected siblings), with a mean age of 8.5 years (range 3.2–15.4) and 55% male, were enrolled. Of the probands, 23% (n = 6) had a confirmed diagnosis of autism spectrum disorder (ASD) and were all male. Gait assessments included 6-min walk test (6MWT), 10-m walk/run test (10MWR), timed-up-and-go test (TUG), and spatio-temporal measurements of preferred- and fast-paced walking. The Pediatric Evaluation of Disability Inventory-Computer Adaptive Tests (PEDI-CAT), a caregiver-reported functional assessment, was administered. Measures of balance were calculated using percent time in double support and base of support. Analyses of the six children with ASD were described separately.ResultsThirty-six participants completed the protocol. Compared with sibling controls, probands had significantly lower scores on the 6MWT (p = 0.04), 10MWR (p = 0.01), and TUG (p = 0.005). Group differences were also identified in base of support (p = 0.003). Probands had significantly lower PEDI-CAT scores in all domains including the mobility scale (p < 0.001). Using age-matched subsamples, the ASD and non-ASD genetic variant groups had larger base of support compared to the controls. In the fast-paced condition, all participants increased their velocity, and there was a corresponding decrease in percent time in double support compared to the preferred-pace condition in all participants. Only the ASD group presented with upper limb arm/hand stereotypies.ConclusionsChildren with 16p11.2, with and without ASD, present with balance impairment during locomotion activities. Probands performed worse on functional assessments, and quantitative measures revealed differences in base of support. These results highlight the importance of using precise measures to differentiate motor dysfunction in children with neurodevelopmental disorders.

Gait synergetic neuromuscular control in children with cerebral palsy at different gross motor function classification system levels.

Cerebral palsy (CP) is a neural developmental disease featured with gait abnormalities. CP gait assessment is usually performed with the Gross Motor Function Classification System (GMFCS) in clinics, which does not involve a thorough assessment of neuromuscular control. To understand how the neuromuscular control disorders lead to gait abnormalities, we explored the relationship between GMFCS levels and the gait synergetic control characteristics in this study. In total, 18 children with CP at different GMFCS levels (mean age: 4.41±1.30 yr) and 8 age-matched typically developing (TD) children (mean age: 4.43±1.36 yr) were recruited to perform a straight walking task, and the surface electromyographic (sEMG) signals from eight lower limb muscles on each side and accelerometer data were collected. A nonnegative matrix factorization method was applied to obtain the muscle synergies from the sEMG signals. Next, synergy structures were projected onto the basic gait synergies to test the completeness of those structures. Subsequently, synergy activation parameters, including total activation duration and coactivation index, were compared across the participants. This study showed that children with CP at GMFCS levels I and II and the TD children had similar synergy structures, but the synergy activations of these children with CP were different from those of TD children. In addition, similar to previous research, we also found that children with CP at GMFCS level III could not access all four basic synergies on both sides. Based on the synergy analysis results, a gait assessment paradigm was proposed to facilitate the clinical CP gait evaluation. NEW & NOTEWORTHY Understanding the mechanism of gait abnormality has important clinical significance for the diagnosis, prognosis, and possible treatment of motor dysfunction in children with cerebral palsy (CP). In this study, the comparisons of the lower limb muscle synergies among different groups of children with CP at different Gross Motor Function Classification System levels might provide some new insight into the mechanism underlying the gait disorder. In particular, the discrepancies of gait synergy structure and activation patterns across the study groups may indicate different neurophysiological and pathological attributes in different groups of patients.

プレ・スピーチの評価と治療：脳性麻痺児の口腔 ―顔面運動機能障害に対する神経発達学的治療アプローチ―

プレ・スピーチの評価と治療：脳性麻痺児の口腔 ―顔面運動機能障害に対する神経発達学的治療アプローチ―

Wrist position sense acuity and its relation to motor dysfunction in children with developmental coordination disorder

This study obtained objective measures of wrist position sense to verify that children with DCD have proprioceptive deficits. In addition, it examined the relationship of wrist proprioceptive impairment with fine motor and balance function. Twenty children with DCD and thirty typically developing children (TD) aged 10–11 years old were recruited and screened using the Movement Assessment Battery for Children (MABC-2). The DCD group had total MABC-2 score below 5th percentile, and TD group was above 25th percentile. Wrist position sense was assessed under two conditions: 1) an ipsilateral wrist joint position matching requiring active movement to reproduce a reference position, and 2) a psychophysical discrimination threshold testing, in which the wrist joint was passively rotated. The results showed that, in comparison to TD controls, the DCD group showed an increased joint position error variability during active matching (p < 0.05) and highly elevated mean position sense threshold for passive displacement (+71%; p < 0.001). Position sense threshold data correlated significantly with manual dexterity (r = −0.4) and balance scores (r = −0.5). This study documents that DCD is associated with a proprioceptive dysfunction of the wrist/hand complex, which likely contributes to the fine motor problems in children with DCD.

Cognitive and motor outcomes in children with unilateral Sturge–Weber syndrome: Effect of age at seizure onset and side of brain involvement

PurposeMost children with Sturge–Weber syndrome (SWS) develop seizures that may contribute to neurocognitive status. In this study, we tested the hypothesis that very early seizure onset has a particularly detrimental effect on the cognitive and/or motor outcomes of children with unilateral SWS. We also tested whether side of SWS brain involvement modulates the effect of seizure variables on the pattern of cognitive abnormalities. MethodsThirty-four children (22 girls; mean age 6.1years) with unilateral SWS and history of epilepsy in a longitudinal cohort underwent neurological and cognitive evaluations. Global intelligent quotient (GIQ), verbal intelligent quotient (VIQ), nonverbal intelligent quotient (IQ), and motor function were correlated with epilepsy variables, side and extent of brain involvement on magnetic resonance imaging (MRI). ResultsMean age at seizure onset was 1.3years (0.1–6years) and mean IQ at follow-up was 86 (45–118). Age at seizure onset showed a logarithmic association with IQ, with maximum impact of seizures starting before age 1year, both in uni- and multivariate regression analyses. In the left SWS group (N=20), age at seizure onset was a strong predictor of nonverbal IQ (p=0.001); while early seizure onset in the right-hemispheric group had a more global effect on cognitive functions (p=0.02). High seizure frequency and long epilepsy duration also contributed to poor outcome IQ independently in multivariate correlations. Children with motor involvement started to have seizures at/before 7months of age, while frontal lobe involvement was the strongest predictor of motor deficit in a multivariate analysis (p=0.017). ConclusionThese findings suggest that seizure onset prior to age 1year has a profound effect on severity of cognitive and motor dysfunction in children with SWS; however, the effect of seizures on the type of cognitive deficit is influenced by laterality of brain involvement.

Slow reading in children with anisometropic amblyopia is associated with fixation instability and increased saccades

Previous studies show slow reading in strabismic amblyopia. We recently identified amblyopia, not strabismus, as the key factor in slow reading in children. No studies have focused on reading in amblyopic children without strabismus. We examined reading in anisometropic children and evaluated whether slow reading was associated with ocular motor dysfunction in children with amblyopia. Anisometropic children (7-12years) with or without amblyopia were compared to age-similar normal controls. Children silently read a grade-appropriate paragraph during binocular viewing. Reading rate (words/min), number of forward and regressive saccades (per 100 words) and fixation duration were recorded with the ReadAlyzer. Binocular fixation instability was also evaluated (EyeLink 1000). Amblyopic anisometropic children read more slowly (n=25; mean with standard deviation, 149±42 words/min) than nonamblyopic anisometropic children (n=15; 196±80 words/min; P=0.024) and controls (n=25; 191±65 words/min; P=0.020). Nonamblyopic anisometropic children read at a comparable rate to controls (P=0.81). Slow reading in amblyopic anisometropic children was correlated with increased forward saccades (r=-0.84, P<0.001), increased regressive saccades (r=-0.85, P<0.001), and fellow eye instability during binocular viewing (r=-0.52, P=0.019). Slow reading in school-age children with anisometropic amblyopia is related to increased frequency of saccades and fixation instability of the fellow eye. Further research should consider the effects of slower reading on academic performance.

Severity of motor dysfunction in children with cerebral palsy seen in Enugu, Nigeria.

IntroductionChildren with cerebral palsy (CP) have gross motor dysfunction (GMD) of varying degrees of severity. The Gross Motor Function Classification System (GMFCS) is widely used internationally to classify children with CP into functional severity levels. There are few reports on the use of GMFCS in Nigeria to determine the severity of motor dysfunction in children with CP. This study aims to classify children with CP in Enugu on the basis of severity of their GMD in order to ascertain their management needs.MethodsThe study was a cross sectional observational study and sample selection was by consecutive recruitment. One hundred (100) children with CP aged 9 – 96 months, attending two Pediatric Neurology Clinics in Enugu, were consecutively recruited. Relevant history was taken including modalities of treatment received. Neurological examination was done and the GMFCS manual was used to classify the children into levels of severity.ResultsGMD varied in severity in the patients from mild (47%) (GMFCS levels I & II) to moderate (7%) (GMFCS levels III) and to severe (46%) (GMFCS levels IV & V). Those in levels I – III (54%) were ambulatory while those in levels IV & V (46%) were non-ambulatory. Of the 53 that required mobility assistive device, only 6 (11.3%) were using one.ConclusionMore than half of CP patients seen in Enugu were ambulatory with mild to moderate motor dysfunction based on the GMFCS. Only a few of our patients are appropriately rehabilitated with augmentative interventions.

Evidence of motor-control difficulties in children with attention deficit hyperactivity disorder, explored through a hierarchical motor-systems perspective

ABSTRACTIntroduction: Attention deficit hyperactivity disorder (ADHD) may reflect a disorder of neural systems that regulate motor control. The current study investigates motor dysfunction in children with ADHD using a hierarchical motor-systems perspective where frontal–striatal/“medial” brain systems are viewed as regulating parietal/“lateral” brain systems in a top down manner, to inhibit automatic environmentally driven responses in favor of goal-directed behavior. It was hypothesized that due to frontal–striatal hypoactivation, children with ADHD would have difficulty with higher order motor control tasks felt to be dependent on these systems, yet have preserved general motor function. Method: A total of 63 children—ADHD and matched controls—completed experimental motor tasks that required maintenance of internal motor representations and the ability to inhibit visually driven responses. Children also completed a measure of motor inhibition, and a portion of the sample completed general motor function tasks. Results: On motor tasks that required them to maintain internal motor representations and to inhibit automatic motor responses, children with ADHD had significantly greater difficulty than controls, yet on measures of general motor dexterity, their performance was comparable. Children with ADHD displayed significantly greater intraindividual (subject) variability than controls. Intraindividual variability (IIV) contributed to variations in performance across the motor tasks, but did not account for all of the variance on all tasks. Conclusions: These findings suggest that children with ADHD may be more controlled by external stimuli than by internally represented information, possibly due to dysfunction of the medial motor system. However, it is likely that children with ADHD also display general motor-execution problems (as evidenced by IIV findings), suggesting that atypicalities may extend to both medial and lateral motor systems. Findings are interpreted within the context of contemporary theories regarding motor dysfunction in ADHD, and implications for understanding externalizing behaviors in ADHD are discussed.

Oral methylphenidate alleviates the fine motor dysfunction caused by chronic postnatal manganese exposure in adult rats.

Developmental manganese (Mn) exposure is associated with motor dysfunction in children and animal models, but little is known about the underlying neurochemical mechanisms or the potential for amelioration by pharmacotherapy. We investigated whether methylphenidate (MPH) alleviates fine motor dysfunction due to chronic postnatal Mn exposure, and whether Mn exposure impairs brain extracellular dopamine (DA) and norepinephrine (NE) in the prefrontal cortex (PFC) and striatum in adult animals. Rats were orally exposed to 0 or 50 mg Mn/kg/day from postnatal day 1 until the end of the study (PND 145). The staircase test was used to assess skilled forelimb function. Oral MPH (2.5 mg/kg/day) was administered daily 1 h before staircase testing for 16 days. DA and NE levels were measured by dual probe microdialysis. Results show that Mn exposure impaired reaching and grasping skills and the evoked release of DA and NE in the PFC and striatum of adult rats. Importantly, oral MPH treatment fully alleviated the fine motor deficits in the Mn-exposed animals, but did not affect forelimb skills of control rats not exposed to Mn. These results suggest that catecholaminergic hypofunctioning in the PFC and striatum may underlie the Mn-induced fine motor dysfunction, and that oral MPH pharmacotherapy is an effective treatment approach for alleviating this dysfunction in adult animals. The therapeutic potential of MPH for the treatment of motor dysfunction in Mn-exposed children and adults appears promising pending further characterization of MPH efficacy in other functional areas (eg, attention) believed to be affected by developmental Mn exposure.

School-Age Outcomes of Very Preterm Infants After Antenatal Treatment With Magnesium Sulfate vs Placebo

Survival rates for infants born at less than 28 weeks’ gestation have increased, but rates of adverse long-term neurodevelopmental outcomes remain high compared with outcomes for term infants. The ACTOMgSO4 (Australasian Collaborative Trial of Magnesium Sulphate) study was designed to determine whether antenatal magnesium sulfate given to women at risk of preterm birth at less than 30 weeks’ gestation was related to mortality and neurosensory morbidity, particularly cerebral palsy (CP), in early childhood. The aim of the present study was to determine outcomes into school age from antenatal magnesium sulfate compared with placebo. Of 1062 parturients at less than 30 weeks’ gestation with birth planned or expected within 24 hours, 535 were randomized to receive intravenously administered magnesium sulfate and 527 to receive normal saline placebo. These women had a total of 1255 fetuses alive at randomization, and 1066 survived to hospital discharge (n = 544 exposed, n = 522 placebo). The outcomes for the school-age follow-up were CP, motor function, general intellectual ability, academic skills, attention, executive function, behavior, growth, functional and other neurosensory outcomes, and mortality. The severity of gross motor dysfunction in children with CP was classified according to the Gross Motor Function Classification System or by the Movement Assessment Battery for Children (MABC). General cognitive ability was assessed using the Wechsler Intelligence Scale for Children. Academic skills were assessed using the Wide Range Achievement Test. Attention and executive function were assessed with tests sensitive to specific attentional and executive processes. Attention-deficit/hyperactivity disorder symptoms were evaluated with parent and teacher versions of the Conners’ ADHD/DSM-IV Scales. Of the 1255 fetuses alive at randomization, the known mortality rate to school age was 14.0% in the magnesium sulfate group (88/629) compared with 17.6% in the placebo group (110/626), not a statistically significant difference. The final analysis included 867 children (443 magnesium sulfate and 424 placebo) for follow-up at school age; outcomes were determined for 669 (77%). Both groups were assessed at a mean age of 8.4 ±1.0 years, corrected for prematurity. The groups were similar for important perinatal, sociodemographic, and 2-year outcome variables. The 2 groups had no statistically significant differences in proportions with CP or in its severity (8% vs 7%; odds ratio, 1.26; 95% confidence interval [CI], 0.84–1.91). A 96% agreement was found between a diagnosis or not of CP at age 6 to 11 years with that at age 2 years in children assessed at both ages; 11 children with CP at age 2 years no longer had the diagnosis at age 6 to 11 years, and 16 children with no CP at age 2 years had the diagnosis at 8 years. Motor function on the Gross Motor Function Classification System and distribution on the MABC centiles (29 vs 32 centile; mean difference, −2.8; 95% CI, −9.1 to 3.5) were similar between groups. The proportions with abnormal motor function based on the MABC and definite motor dysfunction were similar (27% vs 27%; odds ratio, 1.16; 95% CI, 0.88–1.52). The groups did not differ in cognitive, academic, attention, executive function, or behavioral outcomes or in any of the growth, functional, or other neurosensory outcomes. Potentially confounding social variables and sex of the child had little effect and changed no conclusions. In this study, antenatal magnesium sulfate was not associated with any long-term benefits or harms compared with placebo. Magnesium sulfate given to mothers just before preterm birth for fetal neuroprotection has been one of the few measures available to possibly improve neurologic outcome for preterm survivors. Other adequately powered studies are needed to evaluate long-term benefit of magnesium for fetal neuroprotection.

Altered microstructural connectivity of the superior and middle cerebellar peduncles are related to motor dysfunction in children with diffuse periventricular leucomalacia born preterm: A DTI tractography study

PurposeTo investigate the microstructural integrity of superior cerebellar peduncles (SCP) and middle cerebellar peduncles (MCP) by using DTI tractography method, and further to detect whether the microstructural integrity of these major cerebellar pathways is related to motor function in children with diffuse periventricular leucomalacia (PVL) born preterm. Materials and methods46 children with diffuse PVL (30 males and 16 females; age range 3–48 months; mean age 22.4±6.7 months; mean gestational age 30.5±2.2 weeks) and 40 healthy controls (27 males and 13 females; age range 3.5–48 months; mean age 22.1±5.8 months) were enrolled in this study. DTI outcome measurements, fractional anisotropy (FA), for the SCP, MCP and cortical spinal tract (CST) were calculated. The gross motor function classification system (GMFCS) was used for assessing motor functions. ResultsCompared to the controls, patients with diffuse PVL had a significantly lower FA in bilateral SCP, MCP and CST. There was a significant negative correlation between GMFCS levels and FA in bilateral SCP, MCP and CST in the patients group. In addition, significant inverse correlation of FA value was found between not only the contralateral but also the ipsilateral CST and SCP/MCP. ConclusionsThese findings suggest that the injury of SCP and MCP may contribute to the motor dysfunction of diffuse PVL. Moreover, the correlations we found between supratentorial and subtentorial injured white matter extend our knowledge about the cerebro-cerebellar white matter interaction in children with diffuse PVL.

Effects of individualized therapeutic porgram with heat-reinforcing needling in combination with Bobath therapy on gross motor dysfunction in children with cerebral palsy: a randomized controlled trial

ObjectiveTo explore the effect of heat-reinforcing acupuncture combined with Bobath rehabilitation training for the gross motor function measurement (GMFM) in children with cerebral palsy. MethodsSixty cases of cerebral palsy were randomized into a heat-reinforcing acupuncture combined with rehabilitation training group (group A) and a rehabilitation group (group B), 30 cases in each group. Rehabilitation training was applied in group B and heat-reinforcing acupuncture was added in group A. Jiāj▪ (▪ EX-B 2), Jiānyú (▪ LI 15), Qūchí (▪ LI 11), Hégŭ (▪ LI 4), Yánglíngquán (▪ GB 34), Yīnlíngquán (▪ SP 9), Xuánzhōng (▪ GB 39), Zúsānl▪ (▪ ST 36), Sānyīnjiāo (▪ SP 6), Chéngshān (▪ BL 57), Tài chōng (▪ LR 3), Tàixī (▪ KI 3) and Shénmén (▪ HT 4) were chosen in group A and the heat-reinforcing acupuncture was applied once a day. For scalp acupuncture, Băihuì (▪ GV 20), Sìshéncōng (▪ EX-HN 1), Zhìsānzhēn (▪), N▪osānzhēn (▪), Nièsānzhēn (▪) and motor area (▪) were punctured without any manipulation, once every other day, 3 months as a treatment course and 2 courses were needed. GMFM were selected to assess the children with cerebral palsy before treatment, after 3 months treatment and after 6 months treatment. ResultsThe total effective rate in group A was 70.00% (21/30), which is superior to that of 60.00% (24/30) in group B (P<0.05). In group A, the GMFM scores of decubitus position and turn-over of body, creeping and kneeling, sitting, standing, walking, running and jumping after 6 months treatment were significantly improved compared with that before treatment and after 3 months treatment (all P<0.05). In group B, above indices after 6 months treatment were significantly improved compared with those before treatment, the standing score after 6 months treatment was significantly improved compared with that after 3 months treatment (P<0.05); the GMFM scores of creeping, kneeling, sitting, standing, walking, running and jumping after 6 months treatment in group A were more significantly improved than that in group B (all P<0.05). ConclusionThe heat-reinforcing acupuncture combined with Bobath rehabilitation training has a better effect than rehabilitation training on the GMFM scores of creeping and kneeling, sitting, standing, walking, running and jumping of children with cerebral palsy. It can be shown that the combination of heat-reinforcing acupuncture and Bobath rehabilitation training can improve the gross motor function of children with cerebral palsy.